To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Advance care planning (ACP) is the process of helping individuals plan for their future by identifying goals of care and preferences for future care, identifying key decision makers should they be unable to make their own decisions. Hemato-oncology is a challenging specialism, one in which the transition from curative to end-of-life can be very rapid, with many patients dying in acute settings while receiving active treatment. As such, it is an area in which ACP is frequently overlooked. This qualitative study aimed to gain a better understanding of the perceived barriers and facilitators to ACP from a clinicians perspective at a large tertiary hematology center.
Methods
A questionnaire was designed and sent electronically to 39 clinical practitioners, including consultant hematologists, resident and specialty doctors, physician associates, and clinical nurse specialists. Responses were categorized following structured thematic analysis into 7 identified themes: education, communication, disease and treatment, time, patient and family support, healthcare professional support, and environment.
Results
In total, 67% of healthcare professionals responded to the questionnaire with a median 100% completion of all questions. Staff feel unable to have ACP discussions for a variety of reasons. In analysis, the identified themes had a degree of overlap and commonality, with education identified as a theme central to all. Analysis indicated that education, and more specifically lack thereof, in the field of ACP was having a detrimental effect on staff understanding and therefore significantly impacting the ability of staff to implement ACP in hemato-oncology practice.
Significance of results
Further education is needed for both healthcare professionals and service users around ACP, with a deeper understanding likely to improve utilization in practice. It is proposed that earlier ACP needs to take place to ensure the opportunity is not missed in a group of diseases with prognostic uncertainty.
Mentoring is an important developmental tool for academic scientists. The match between mentor and mentee is a critical factor than can influence outcomes for mentees. However, we know little about what factors should be considered when matching mentors and mentees. We draw on person-environment fit theory to examine how different factors related to the fit between mentors and mentees may influence outcomes for mentees in health-related scientific disciplines.
Methods:
Data were collected from 76 mentor-mentee pairs who participated in a nine-month mentoring program for scientists interested in clinical and translational research. An index of supplementary fit was calculated to reflect mentor-mentee similarity in terms of race/ethnicity, gender, academic discipline, professional track, percent time allocated to research, and type of research. Complementary fit reflected the proportion of skills mentees identified as needs that their mentor felt comfortable providing. Mentee outcomes assessed included satisfaction with one’s mentor, learning and development experiences, and short-term research output.
Results:
As predicted, we found that supplementary fit was positively related to mentee satisfaction with the mentor. We found no support for the expected relationship between complementary fit and mentee learning development experiences or short-term research output. Supplementary analyses explored other non-hypothesized relationships among study variables.
Conclusions:
This research underscores the need to consider different types of fit when matching academic mentors and mentees in clinical and translational science-related disciplines. Our results can be leveraged during the matching process in academic mentoring programs to maximize the success of mentoring relationships for scientists in health-related fields.
Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.
Conflict-related sexual violence and the rights of female victims have received scholarly attention, but the same cannot be said of post-conflict rejection and re-victimization of the victims and the violation of their rights. This article examines the rejection and re-victimization of the returnee victims / survivors of Nigeria’s Boko Haram’s sexual terrorism. It discusses how this violates their fundamental human rights as contained in various UN conventions and other legal frameworks. Relying on a legal-doctrinal approach, it examines these violations and the difficulty in enforcing such rights. Findings reveal that these human rights violations continue through the rejection and re-victimization of victims / survivors by family and community members. Despite these obvious rights violations, it has been difficult to seek legal redress for enforcing such rights due to the absence of political will on the part of the government.
The Ecologies of Violence project examines how war and state violence generate lasting human and more-than-human entanglements that disrupt conventional heritage frameworks. Through international and interdisciplinary case studies, it reveals how structural violence creates involuntary heritage and exclusion zones that call for a planetary, ecological archaeology attuned to the multispecies, (im)material, temporal and sociopolitical complexities of conflict.
Childlessness in late male adulthood is increasingly prevalent in rural China, indicating a need to understand the factors contributing to it. This group is often overlooked in gerontological and childlessness research. While existing studies have explored individual-level predictors of childlessness over the lifecourse and implications of broader societal conditions at the population level, little is known about how lifecourse and structural factors interact to shape pathways to childlessness. This study aims to investigate structural factors contributing to childlessness among older men in a rural area of northern China. It focuses on the life stories of 13 childless older men and the effects of history, timing and life-domain interdependencies, finding that some participants experienced intense disruptive life events or critical turning points – early-life care-giving responsibilities, disability or withdrawal from school – that altered their life trajectories. These events often intersected with structural factors, including unstable and low-paid employment, lack of social protection and prevailing social norms, which reinforced one another and jointly constrained prospects for marriage and parenthood. These trajectories unfolded within shifting policy contexts; institutional arrangements across different historical periods shaped and often produced disadvantages in the marriage market. This study advances theoretical understanding of the structural factors contributing to male childlessness by recognizing life trajectories, structural shifts and social relations as linked factors shaping cumulative disadvantage in union formation and childbearing. Its policy implications surround supporting individuals who intend to form families during critical life transitions and addressing the broader structural barriers that shape male childlessness in rural areas.
This numerical investigation focuses on the mechanisms, flow topology and onset of Kelvin–Helmholtz instabilities (KHIs), that drive the leading-edge shear-layer destabilisation in the wake of wall-mounted long prisms. Large-eddy simulations are performed at ${\textit{Re}} = 2.5\times 10^3, 5\times 10^3$ and $1\times 10^4$ for prisms with a range of aspect ratio (AR, height-to-width) between $0.25$ and $1.5$, and depth ratios (DR, length-to-width) of $1{-}4$. Results show that shear-layer instabilities enhance flow irregularity and modulate spanwise vortex structures. The onset of KHI is strongly influenced by depth ratio, such that long prisms (${\textit{DR}}= 4$) experience earlier initiation compared with shorter ones (${\textit{DR}}= 1$). At higher Reynolds numbers, the onset of KHI shifts upstream towards the leading-edge, intensifying turbulence kinetic energy and increasing flow irregularity, especially for long prisms. The results further show that in this configuration, energy transfer from the secondary recirculation region contributes to the destabilisation of the leading-edge shear layer by reinforcing low-frequency modes. A feedback mechanism is identified wherein energetic flow structures propagate upstream through reverse boundary-layer flow, re-energising the leading-edge shear layer. Quantification using probability density functions reveals rare, intense upstream energy convection events, driven by this feedback mechanism. These facilitate the destabilisation process regardless of Reynolds number. This study provides a comprehensive understanding of the destabilisation mechanisms for leading-edge shear layers in the wake of wall-mounted long prisms.
Advancing community engagement and participatory research approaches necessitates shifting cultural norms. The paper describes a program designed to explicitly embed and reinforce a culture of engagement through resource allocation, modeling, and recognition that was initiated by a Clinical and Translational Science Institute Community Engagement Program CE Program. Resources were allocated to the relationship development process between researchers and community partners. Funded partnerships were provided with guidance to support the equitable distribution of resources. Partnerships received additional reinforcement through participation in a learning collaborative, intended to support community partnership development, model best practices in community engagement and to build a network of community engaged, and participatory researchers at the institution. Investigators reported the learning collaborative “gave them permission” to focus on the process. Overall, lessons learned indicate embedding and reinforcing practices that center relationship and reward time spent building partnerships is a promising strategy to buffer against cultural norms that favor outcomes and over process.
Sustainable phosphorus fertilization is a growing challenge in agriculture. Phosphorus is necessary for plant growth, but it is typically only bioavailable in its orthophosphate form. Phosphate fertilizers contribute to environmental damage as they leach into aquatic ecosystems. Therefore, it is imperative to develop new fertilization techniques such as controlled-release small-scale phosphate fertilizers. However, iteratively optimizing various new fertilizers using a comparable method is difficult. Here, we use three-dimensional bioprinting as a high-throughput screening platform to evaluate cellular phosphate uptake of various phosphate sources, including triple super phosphate, diammonium phosphate and struvite, which are composed of different chemistries and scales. As a result, we identified ideal phosphate fertilizer sources for the development of controlled-release phosphate fertilizers. Then, we evaluated whether plant growth and root architecture responded differently to the ideal controlled-release fertilizers. This study demonstrates the utility of this screening platform in developing a controlled-release phosphate fertilizer that effectively provides phosphate to plants at the microparticle scale.
Weed Risk Assessments (WRAs) aim to distinguish potentially invasive plants from non-invasive plants using traits such as the likelihood that the species will be introduced, establish, spread, and/or have negative impacts and (sometimes) whether it can be managed effectively. International standards for the criteria used to assess risk have been proposed to improve the sharing and transferability of WRA results. However, it is unclear whether existing WRAs follow these standards. Here, we compiled a global database of national-level and subnational-level (state/province) WRAs and evaluated their assessment criteria relative to an amended list of proposed minimum standards. We searched for WRAs in 240 countries and retrieved 20 unique assessments associated with 81 countries. The most comprehensive WRA was the “Guidelines for the Generic Ecological Impact Assessment of Alien Species” created by Norway, which satisfied 23 of 24 standards. The International Plant Protection Convention (IPPC) Pest Risk Analysis Framework and the European and Mediterranean Plant Protection Organization (EPPO) Express Pest Risk Analysis were also comprehensive, fulfilling 21 of 24 standards. All national-level WRAs included a description of the focal species’ taxonomy, a description of risk assessment area, an assessment of the likelihood of spread of the focal species, and an assessment of the likelihood of impact of the focal species. Conversely, it was rare for WRAs to include a history of spread of the focal species or an evaluation of the possible effects of climate change. States/provinces showed a similar pattern (i.e., rarely discussed climate change), but also frequently lacked assessment of impact on ecosystem services and metrics of uncertainty. Many WRAs are shared between countries, but few are shared between states/provinces. Adopting similar WRA standards would allow policymakers and governing bodies to more effectively share information and results from completed WRAs, improving consistency of regulated plants across jurisdictional borders.
Approximately 25% of older adult residents who experience an acute change in health status are transferred from Long-Term Care (LTC) to Emergency Departments (ED). We explored the use of an intervention (i.e., LTC to ED) care and referral pathway, INTERACT® Change in Condition cards, and STOP AND WATCH tool, in informing decision making regarding resident transfers. We conducted 22 semi-structured interviews with Health care Providers (HCPs) involved in the LTC to ED care pathway in Western Canada. Thematic analysis of the qualitative interviews was used to evaluate the use of the pathway and tools. We identified six themes influencing decision making around resident transfers including interprofessional practice and conflict, ambiguous and clear medical cases, ageism, health care providers’ goals, family involvement in resident care, and intervention tools. The intervention may be useful in streamlining, documenting, and increasing transparency in complicated LTC resident care and transfer decisions.
Thyroglobulin (Tg) has been considered a measure of iodine status, but there is no global guidance. This analysis examines the relationship between serum Tg and spot urinary iodine concentration (UIC) data to identify Tg concentrations that correspond to current WHO thresholds for population iodine status. We analysed data from 730 non-pregnant Guatemalan women aged 15–49 years who had both UIC and Tg measurements. Correlations were examined. Bootstrap stratified finite sampling with replacement was used to generate cluster k-medians of UIC (mUIC) and Tg (mTg) that served as the population unit of analyses. Non-linear restricted cubic spline regression dose–response curve functions and ordinary differential equations were then used to derive the Tg threshold corresponding to WHO definitions for UIC. Mean age was 30·2 (sd 9·3) years. mTg was 10·4 ng/ml (9·9, 10·8), and mUIC was 148·7 μg/l (139·1, 161·0). Correlations between spot UIC and Tg were NS at the individual level, but correlations based on population k-medians were significant (Spearman r = −0·21 to −0·06, each P < 0·0001) and demonstrated a U-shaped relationship according to WHO categories. Derived mTg cutoffs were 14·2 ng/ml predictive of UIC insufficiency, 10·2 ng/ml for UIC adequacy, 8·5 ng/ml for UIC above adequate and 10·8 ng/ml for UIC excess. The significant and graded mUIC–mTg correlations suggest that Tg concentrations predictive of UIC categories are obtainable for non-pregnant Guatemalan women aged 15–49 years. The newly derived mTg cutoff may be more discriminant at a lower spectrum of UIC in terms of identifying iodine-deficient women, more so than in the UIC excess category.
Psychiatric disorders lead to disability, premature mortality and economic burden, highlighting the urgent need for more effective treatments. The understanding of psychiatric disorders as conditions of large-scale brain networks has created new opportunities for developing targeted, personalised, and mechanism-based therapeutic interventions. Non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can directly modulate dysfunctional neural networks, enabling treatments tailored to the individual’s unique functional network patterns.
As NIBS techniques depend on our understanding of the neural networks involved in psychiatric disorders, this review offers a neural network-informed perspective on their applications. We focus on key disorders, including depression, schizophrenia, and obsessive-compulsive disorder, and examine the role of NIBS on cognitive impairment, a transdiagnostic feature that does not respond to conventional treatments. We discuss the advancements in identifying NIBS response biomarkers with the use of electrophysiology and neuroimaging, which can inform the development of optimised, mechanism-based, personalised NIBS treatment protocols.
We address key challenges, including the need for more precise, individualised targeting of dysfunctional networks through integration of neurophysiological, neuroimaging and genetic data and the use of emerging techniques, such as low- intensity focused ultrasound, which has the potential to improve spatial precision and target access. We finally explore future directions to improve treatment protocols and promote widespread clinical use of NIBS as a safe, effective and patient-centred treatment for psychiatric disorders.
The Resilience Hub was established to support people in need of psychological/psychosocial support following the 2017 Manchester Arena terrorist attack.
Aims
To use mental health screening measures over 3 years following the Arena event to examine the variation in symptoms reported by adults registered with the Hub, and whether this was associated with treatment access characteristics.
Method
Adults engaging with Hub services were separated into eight cohorts depending on when they registered post-incident. Participants completed screening measures for symptoms of trauma, depression, generalised anxiety and work/social functioning. Baseline and follow-up scores over 3 years were compared among the eight admission groups. All types of appointment were recorded in terms of the number of minutes of clinical ‘contact time’ involved, to explore associations with time taken to register.
Results
Overall, baseline screening scores increased as time to register post-event increased. Over the 3 years of follow-up, a decrease in scores was observed for all 4 screening measures, indicating improvement in mental well-being. Those taking longer to register had higher follow-up scores. However, they showed a slightly stronger decrease in average change of score per follow-up month. Mean contact time per month was greater (apart from the 18-months admission group) in individuals delaying registration. Increased contact time was associated with decreased follow-up screening scores for depression and anxiety.
Conclusions
People who registered earlier were less symptomatic, suggesting there may be a potential beneficial impact of early engagement with support services following traumatic events. All who registered showed improvement in symptoms, including those delaying registration, with increased contact time being beneficial. This reinforces the benefits of encouraging early and sustained engagement with services as soon as possible post-incident.
The Mexican Cristero experience constituted a political laboratory and a school of resistance providing blueprints of action later exercised in Spain. With barely ten years between their own countries’ conflicts, the ladies of Catholic Action—in Mexico and then in Spain—organized themselves, first, as a passive resistance, and then both used the same justifications to support the use of political violence. News of the Mexican Catholic women’s experience had arrived across the Atlantic in the chronicles of Spanish newspapers beginning in the late 1920s and in the edifying, right-leaning novels that were spread, above all, in Spanish Catholic schools during the 1930s. This helps us understand the parallels between the actions, liaisons, informants, and weapons suppliers of the Brigades and other Catholic organizations in Mexico and the members of the women’s fifth column in Spain. Perhaps the contemporary presence in the public sphere of European fascists resonated more among young urban Madrid or Barcelona women during the Spanish Civil War, but, without a doubt, the social origin, experience, and cultural heritage of Mexican women was more in line with the efforts of conservative Spanish women all over the country during the conflict. In both cases, the defence of religion and their Catholic identity was at the forefront of their efforts and gave coherence to what might, at times, appear to be diverse political projects.
The aim of this paper is to illustrate both analytically and numerically the interplay of two fundamentally distinct non-Hermitian mechanisms in the deep subwavelength regime. Considering a parity-time symmetric system of one-dimensional subwavelength resonators equipped with two kinds of non-Hermiticity – an imaginary gauge potential and on-site gain and loss – we prove that all but two eigenmodes of the system pass through exceptional points and decouple. By tuning the gain-to-loss ratio, the system changes from a phase with unbroken parity-time symmetry to a phase with broken parity-time symmetry. At the macroscopic level, this is observed as a transition from symmetrical eigenmodes to condensated eigenmodes at one edge of the structure. Mathematically, it arises from a topological state change. The results of this paper open the door to the justification of a variety of phenomena arising from the interplay between non-Hermitian reciprocal and nonreciprocal mechanisms not only in subwavelength wave physics but also in quantum mechanics, where the tight-binding model coupled with the nearest neighbour approximation can be analysed with the same tools as those developed here.
Contemporary society faces significant challenges that can lead to stress-induced tunnel vision. Positive affect can counteract these effects by expanding humans’ attentional scope, potentially promoting resilience and creativity. This preregistered triple-blind study investigated the role of endogenous opioids in mediating attentional broadening following reward receipt.
Methods
Using a placebo-controlled crossover design, 40 volunteers underwent two sessions separated by at least 1 week, receiving either 50 mg of naltrexone or a placebo. Participants completed a Navon letters task designed to contrast the effects of reward receipt versus reward anticipation on attentional scope.
Results
As predicted, our results show that the attentional broadening observed after reward receipt under placebo was eliminated when opioid receptors were blocked. Naltrexone did not result in blunted reward anticipation effects on task performance or attentional narrowing.
Conclusions
This study highlights the role of endogenous opioids in attentional breadth and their potential for cognitive flexibility and resilience through natural positive experiences, with potential implications for mental health and stress management.
A company with n geographically widely dispersed sites seeks an insurance policy that pays off if m out of the n sites experience rarely occurring catastrophes (e.g., earthquakes) during a year. This study compares three strategies for an insurance company wishing to offer such an m-out-of-n policy, assuming the existence of markets for insurance on the individual sites with coverage periods of various lengths of a year or less. Strategy A is static: at the beginning of the year it buys a reinsurance policy on each individual site covering the entire year and makes no later adjustments. By contrast, Strategies S and C are dynamic and adaptive, exploiting the availability of individual-site policies for shorter periods than a year to make changes in the coverage on individual sites as quakes occur during the year. Strategy S uses the payoff from reinsurance when a quake occurs at a particular site to increase coverage for the remainder of the year on the sites that have not yet had quakes. Strategy C buys individual-site policies covering successive time periods of fixed length, observing the system at the beginning of each period and using cash on hand plus cash obtained from a reinsurance payoff (if any) during the previous period to decide how much cash to retain and how much reinsurance to purchase for the current period. The study relies on expected utility to determine indifference premiums and compare the premiums and loss probabilities for the three strategies.
Although guidelines recommend targeted vitamin D testing for high-risk populations, testing has increased globally. Limited studies have examined real-world testing patterns and their relationship with deficiency outcomes. This study investigates trends, demographic determinants and deficiency outcomes associated with voluntary vitamin D testing among Taiwanese adults.
Design:
A retrospective cohort study analysing electronic medical records to assess vitamin D testing trends, demographic predictors of deficiency and status changes following consecutive tests within 2 years. Vitamin D status was classified based on serum 25-hydroxyvitamin D levels as deficient (< 20 ng/ml), insufficient (20–29·9 ng/ml) or sufficient (≥ 30 ng/ml).
Setting:
A tertiary medical centre in Taiwan.
Participants:
Between 2013 and 2022, 13 381 outpatients underwent voluntary vitamin D testing. After excluding those aged < 18 years, with advanced renal disease, osteomalacia, rickets or hyperparathyroidism, 8383 were included in the final analysis.
Results:
Testing increased sharply after 2019. Although women underwent twice as many tests, men had a higher deficiency prevalence (56·94 % v. 53·01 %). Adults aged 18–34 years had the highest prevalence (67·81 %). Obstetrics and Gynecology specialists ordered the most tests, particularly for female infertility, with 65·73 % of patients deficient. Among those with repeat tests, deficiency prevalence decreased from 59.32 % to 43·25 %.
Conclusions:
The increase in voluntary vitamin D testing with demographic disparities highlights the importance of understanding testing behaviours and public health implications. Improved vitamin D status at follow-up suggests potential benefits in identifying high-risk individuals and emphasises the need for further research to evaluate outcomes and guide prevention strategies.